Impacts of False Alarms in Critically Ill Patients with Heart and Lung Failure

描述（申请人提供）：这个指导的以患者为导向的研究职业发展奖的目的是准备克里斯托弗P. Bonafide，医学博士，MSCE，儿科助理教授在宾夕法尼亚大学和费城儿童医院，他的长期目标是成为一个独立的临床研究科学家，专注于评估干预措施，以防止在医院心脏骤停和其他不良事件，并将有效的干预措施转化为临床实践。他的近期目标是获得必要的培训，指导和研究经验，以成功地竞争R 01赠款支持在这一领域的干预研究。为了实现这一目标，Bonafide博士和他的导师们制定了一个全面的职业发展计划，包括四个组成部分，包括（a）临床信息学、事件时间分析和临床试验方面的高级培训 设计，（B）来自一个团队的密集指导，Bonafide博士与该团队有着合作和奖学金的良好记录，其中包括罗恩凯伦，医学博士，公共卫生硕士（主要导师），Vinay Nadkarni，医学博士，理学硕士（共同导师），John Holmes博士（共同导师）和Russell Localio博士（高级生物统计学顾问），（c）与临床有效性研究、信息学、（d）一项创新研究计划，以调查生理监测技术的潜在危害，这是识别恶化早期迹象和预防心脏骤停的关键工具。尽管潜力巨大，但生理监测仪每天可以为每位患者生成数百个警报，其中高达86%是错误的。候选人假设错误警报导致警报疲劳，延迟对可能代表即将发生的心脏或呼吸骤停的真实迹象的警报的响应，并且不必要地中断高风险任务，导致错误和患者伤害。Bonafide博士的目标是严格评估假警报在心脏骤停和其他不良事件高风险患者人群中的潜在影响：患有现有或预计心脏和/或肺衰竭的危重儿童。他将使用视频和直接观察方法来（1）通过测量假警报率与护士对关键警报的响应时间之间的关联来评估警报疲劳对患者的影响，以及（2）确定由于生理监测器警报导致的中断与该高风险患者人群中的给药错误之间的关联。研究结果将提供证据，以支持和告知未来的R 01提案，重点是评估改善生理监测器信噪比的策略，并将这些策略转化为临床实践，以防止院内心脏骤停和其他不良事件。上述研究和职业发展活动将在宾夕法尼亚大学和费城儿童医院的合作学术环境中进行，并得到国际公认的导师和顾问团队的支持，确保Bonafide博士的成功。

DESCRIPTION (provided by applicant): The purpose of this Mentored Patient-Oriented Research Career Development Award is to prepare Christopher P. Bonafide, MD, MSCE, Assistant Professor of Pediatrics at the University of Pennsylvania and The Children's Hospital of Philadelphia for his long-term goal of becoming an independent clinical research scientist focused on evaluating interventions to prevent in-hospital cardiac arrest and other adverse events, and translating effective interventions into clinical practice. His immediate goal is to obtain the training, mentorship, and research experience necessary to successfully compete for R01 grants supporting intervention studies in this area. To meet this goal, Dr. Bonafide and his mentors have developed a comprehensive career development plan with four components, including (a) advanced training in clinical informatics, time-to-event analysis, and clinical trial design, (b) intensive mentorship from a team with whom Dr. Bonafide has a track record of collaboration and scholarship including Ron Keren, MD, MPH (primary mentor), Vinay Nadkarni, MD, MS (co-mentor), John Holmes, PhD (co-mentor), and Russell Localio, PhD (senior biostatistics advisor), (c) participation in collaborative research seminars with experts in clinicl effectiveness research, informatics, and medical device engineering, and (d) an innovative research plan to investigate the potential harms associated with physiologic monitoring technology, a critical tool in recognizing early signs of deterioration and preventing cardiac arrest. Despite their great potential, physiologic monitors can generate hundreds of alarms per patient each day, up to 86% of which are false. The candidate hypothesizes that false alarms lead to alarm fatigue, delaying responses to alarms that may represent true signs of impending cardiac or respiratory arrest, and unnecessarily interrupt high-risk tasks leading to errors and patient harm. Dr. Bonafide aims to rigorously evaluate these potential impacts of false alarms in a population of patients at high risk of cardiac arrest and other adverse events: critically ill children with existing or projected heart and/or lung failure. He will use video and direct observational methods to (1) evaluate the patient-oriented impact of alarm fatigue by measuring the association between the rate of false alarms and nurse response time to critical alarms, and (2) determine the association between interruptions due to physiologic monitor alarms and medication administration errors in this high-risk patient population. The findings will provide evidence to support and inform future R01 proposals focused on evaluating strategies to improve the signal-to-noise ratio of physiologic monitors and translating these strategies into clinical practice to prevent in-hospital cardiac arrest and other adverse events. The research and career development activities outlined above will take place in the collaborative academic environment of the University of Pennsylvania and The Children's Hospital of Philadelphia with the support of an internationally-recognized team of mentors and advisors, assuring Dr. Bonafide's success.